Mountain K E, Ng S, Elger T, Judah H, Akolekar R, Lewis H V, MacIntyre D A, Terzidou V, Bennett P R, Teoh T G, Sykes L, Nicolaides K H
March of Dimes Prematurity Research Centre at The Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
The Parasol Foundation Centre for Women's Health and Cancer Research, Imperial College Healthcare NHS Trust, London, UK.
Ultrasound Obstet Gynecol. 2025 Aug;66(2):210-216. doi: 10.1002/uog.29281. Epub 2025 Jul 9.
Cervical cerclage is an important treatment used to prevent spontaneous preterm birth (sPTB), but it is not universally successful. Understanding the factors associated with cerclage treatment failure may lead to improved patient selection and better patient outcomes. The objective of this study was to investigate the value of pre- and post-cerclage cervical length (CL) in predicting sPTB < 34 weeks.
This was a retrospective cohort study conducted in four preterm birth prevention clinics in the UK. We included 331 women who had undergone cervical cerclage between January 2008 and March 2021, and analyzed their pre- and post-cerclage CL, as measured by transvaginal ultrasound scan. The primary outcome was sPTB < 34 weeks' gestation, assessed using multivariable logistic regression modeling (variables were pre- and post-cerclage CL, gestational age at cerclage and direction of CL change) and the generation of receiver-operating-characteristic (ROC) curves. Differences in sPTB for underlying risk factors (race, smoking history, previous cervical surgery or pregnancy history risk factors, including mid-trimester loss or sPTB) were assessed using Fisher's exact test.
Both pre- and post-cerclage CL were independently discriminative of sPTB < 34 weeks' gestation, with areas under the ROC curve of 0.635 (95% CI, 0.559-0.712) and 0.677 (95% CI, 0.604-0.751), respectively, and were modest contributors to sPTB prediction based on multivariable logistic regression modeling (odds ratio (OR), 0.964 (95% CI, 0.936-0.994), P = 0.018 and 0.940 (95% CI, 0.910-0.970), P < 0.001, respectively). There were no significant differences in the rate of sPTB < 34 weeks' gestation according to race, smoking history, previous cervical surgery or pregnancy history risk factors, including previous mid-trimester loss or sPTB.
Post-cerclage CL is the predominant predictor of sPTB < 34 weeks' gestation. Underlying sPTB risk factors (previous cervical surgery and pregnancy history) may influence pre-cerclage CL and the direction of CL change following cerclage, but once these are adjusted for, they do not influence the risk of sPTB < 34 weeks' gestation. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
宫颈环扎术是预防自发性早产（sPTB）的重要治疗方法，但并非总能成功。了解与环扎术治疗失败相关的因素可能有助于改善患者选择并提高治疗效果。本研究的目的是探讨环扎术前和术后宫颈长度（CL）在预测孕周＜34周的sPTB中的价值。
这是一项在英国四家早产预防诊所进行的回顾性队列研究。我们纳入了2008年1月至2021年3月期间接受宫颈环扎术的331名女性，并分析了经阴道超声扫描测量的她们环扎术前和术后的CL。主要结局是孕周＜34周的sPTB，采用多变量逻辑回归模型（变量为环扎术前和术后的CL、环扎时的孕周以及CL变化方向）进行评估，并绘制受试者工作特征（ROC）曲线。使用Fisher精确检验评估潜在风险因素（种族、吸烟史、既往宫颈手术史或妊娠史风险因素，包括孕中期流产或sPTB）导致的孕周＜34周的sPTB发生率差异。
环扎术前和术后的CL均能独立区分孕周＜34周的sPTB，ROC曲线下面积分别为0.635（95%CI，0.559 - 0.712）和0.677（95%CI，0.604 - 0.751），根据多变量逻辑回归模型，它们对sPTB预测的贡献较小（优势比（OR）分别为0.964（95%CI，0.936 - 0.994），P = 0.018和0.940（95%CI，0.910 - 0.970），P ＜ 0.001）。根据种族、吸烟史、既往宫颈手术史或妊娠史风险因素（包括既往孕中期流产或sPTB），孕周＜34周的sPTB发生率无显著差异。
环扎术后的CL是孕周＜34周的sPTB的主要预测指标。潜在的sPTB风险因素（既往宫颈手术史和妊娠史）可能影响环扎术前的CL以及环扎术后CL的变化方向，但在对这些因素进行调整后，它们并不影响孕周＜34周的sPTB风险。© 2025作者。《妇产科超声》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
